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Clinical Med B > Middle and outer ear trigger > Flashcards

Middle and outer ear trigger Flashcards

1
Q

Pseudomonas is the MCC of which ear problems

A

diffuse AOE “swimmers ear”
Malignant/necrotizing COE
Chronic suppurative OM
perichondritis (+staph Aureus)

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2
Q

Staph Aureus is the MCC of which ear problems

A

Perichondritis (+psuedomonas)
Auricular Cellulitis ( + strep)
Localized AOE furunculosis

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3
Q

can be caused by overcleaning ear

A

diffuse AOE swimmers ear

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4
Q

itching, severe pain, conductive hearing loss and sense of fullness/pressure

A

diffuse AOE swimmers ear

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5
Q

erythematous canal, otorrhea, difficulty visualizing TM, moist debris present in canal

A

diffuse AOE swimmers ear

also see:
pain upon tragus palpation or auricle retraction

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6
Q

pain upon tragus palpation or auricle retraction

A

diffuse AOE swimmers ear

also see:
erythematous canal, otorrhea, difficulty visualizing TM, moist debris present in canal

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7
Q

topical ofloxacin/ciprofloxacin or cortisporin. If severe oral cipro and/or steroids.

A

diffuse AOE swimmers ear

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8
Q

Treated with dicloxacillin or keflex

A

localized AOE furunculosis

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9
Q

caused by aspergillosis

A

COE otomycosis

can also be caused by candidiases

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10
Q

risk factor is previous use of antibiotics in ear

A

COE otomycosis

risk factor is also hot/humid

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11
Q

deep seated itching, discomfort and discharge

A

COE otomycosis

also presents with:
mild pain
soft/white mold in ear

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12
Q

treated with clotrimazole 1% solution

A

COE otomycosis

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13
Q

can be caused by Seborrhic dermatitis or contact dermatitis

A

Non-infective COE

also caused by psoriasis

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14
Q

can be caused by psoriasis

A

non-infective COE

also by: contact or seborrhic dermatitis

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15
Q

presents as red, scaly, dry skin

A

non-infective COE

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16
Q

treated with topical or otic hydrocortisone

A

non-infective COE

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17
Q

pts who are immunocompromised or elderly are at higher risk for this ear disease

A

necrotizing otitis externa

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18
Q

this ear problem can spread to the base of the skull potentially causing osteomyelitis

A

necrotizing otitis externa

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19
Q

deep seated pain disproportionate to exam findings

A

necrotizing otitis externa

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20
Q

purulent otorrhea with temporal HA

A

necrotizing otitis externa

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21
Q

granulation tissue at bony cartilaginous junction of ear canal floor

A

necrotizing otitis externa

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22
Q

must obtain CT scan to evaluate

A

necrotizing otitis externa

also need tissue biopsy

CT scan is also used to evaluate mastoiditis so that is also correct!

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23
Q

must obtain tissue biospy to evaluate

A

necrotizing otitis externa

must also get a CT scan

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24
Q

aggressive glycemic control as tx

A

necrotizing otitis externa

also use:
IV cipro
followed by oral cipro
with surgical debridement if severe/refractory

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25
Q

when is IV cipro indicated

A

necrotizing otitis externa
followed by oral cipro
also use glycemic control

can also be used in perichondritis

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26
Q

Gallium nuclear scan is used for what

A

necrotizing otitis externa. Only when no more inflammation is seen on this scan can you stop the cipro

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27
Q

geniculate ganglion infection

A

herpes zoster oticus

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28
Q

vascular rash

A

herpes zoster oticus

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29
Q

can be mistaken as bells palsy

A

herpes zoster oticus

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30
Q

severe otalgia and facial palsy

A

herpes zoster oticus aka ramsay hunt

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31
Q

treat with prednisone in tandem to another med…. what is the diagnosis? what is the other med?

A

sorry i know this was rude but it would have given it away

Dx: Herpes Zoster Oticus
Tx: prednisone + famciclovir or valcyclovir

note: if you said AOE or auditory eustachian tube dysfunction you are technically not wrong cuz these are treated with steroids!

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32
Q

what ear problems can be caused by overcleaning the ear

A

cerumen impaction
swimmers ear

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33
Q

when do we see 3% h2o2 and detergent ear drops such as debrox and cerumex

A

at home cerumen impaction removal

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34
Q

warm moist environmens cause increased risk of what types of ear problems

A

swimmers ear
otomycosis

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35
Q

what problems involve the perichondria

A

auricle hematoma: collection of blood under perichondria

Perichondritis: infection of perichondrium

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36
Q

often a result of trauma (there are multiple)

A

auricle hematoma
auricular cellulitis
perichondritis

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37
Q

direct trauma to anterior auricle

A

auricle hematoma

38
Q

How do you treat an auricle hematoma?

A
  • 7 days of onset to prevent cosmetic damage.
  • Lidocaine 1% (4 locations, stick twice)
  • I&D
  • NS Irrigation
  • Compression Dressing for 7 days (check daily)
  • ABX prophylaxis (maybe)
39
Q

avoid NSAID use

A

auricle hematoma

40
Q

What nerves must be blocked for a complete auricle block?

A
  • Lesser occipital nerve
  • Greater auricular nerve
  • Auriculotemporal nerve
41
Q

assess for basilar skull fracture, TM and canal damage as well as the function of the facial nerve.

may also want to check for hearing deficits

A

things we need to check with auricular lacerations

42
Q

primary closure with interrupted sutures

A

auricular laceration

43
Q

MC organisms for this include Staph Aureus and strep

A

auricular cellulitis

44
Q

Treat with Keflex, bactrim or clinda

A

auricular cellulitis

45
Q

IV vanc

A

auricular cellulitis when presenting with:
tachycardia
rapid progression of erythema
progressing of s/s despite abx
systemic toxicity (fever >100.5)

46
Q

tachycardia, rapid progression of erythema, progressing of s/s despite abx, or systemic toxicity (fever >100.5)

A

auricular cellulitis needing to be treated with IV vanc

47
Q

caused by MC pseudomonas and S aureus

A

perichondritis

48
Q

MC reason for childhood ABX use.

A

AOM

49
Q

this bacteria causes AOM in older children with more local complications

A

group A strep

50
Q

this bacteria causes acute otorrhea in children with tympanostomy tubes

A

staph

51
Q

this bacteria is MCC of AOM in the first few months of life

A

E coli

52
Q

this bacteria is the cause of chronic, suppurative OM

A

pseudomonas

53
Q

this bacteria is MC of AOM in infants younger than 2 weeks

A

Group B strep

54
Q

Negative pressure followed by accumulation of secretions can cause

A

AOM

55
Q

URI is the MC preceeding factor of what disease

A

AOM

56
Q

Bulging of TM, Poor mobility of TM with erythema present.

A

AOM

57
Q

Suppurative opacities in TM, decreased/absent mobility, otorrhea

A

OM with effusion

58
Q

S. pneumo, M cat, H flu

A

3 MCC of AOM

59
Q

otalgia, hearing loss, present with non specific sympotms such as fever, HA, NVD, irritability, congestion ect

A

AOM

60
Q

AOM mild-mod tx, consider pcn allergy as well

A

amoxicillin 1st line
if not:
omnicef
cefuroxime
azithromycin

61
Q

why do we not prefer to use azithromycin

A

lacks acitivyt against most H flu and 1/3 of pneumococcal isolates

62
Q

If a patient has AOM and has had ABX within the last 30 days what is tx

consider pcn allergy as well

A

amoxicillin + augmentin 1st

then:
omnicef
rocephin
clinda

63
Q

what is given to patients with AOM who have a immediate anaphylactic response to PCN

A

azithromax or docycycline

64
Q

What qualifies as severe AOM?

A

Significant hearing loss
Severe pain
Fever > 102F
Immunocompromised
Under 6mo of age
Marked TM erythema

65
Q

How do you treat severe AOM or AOM w/ associated bacterial conjunctivitis?

A

Augmentin
OR
Rocephin

66
Q

How do you treat severe AOM or AOM w/ associated bacterial conjunctivitis in a patient who has been exposed to abx in the past 30 days or has treatment failure

A

rocephin
clinda
consider tympanocentesis

67
Q

smoking/second hand smoke as risk factor

A

AOM

68
Q

lack of breastfeeding as risk factor

A

AOM

69
Q

when should children stop using a pacifier

A

10 months old

70
Q

what is treated with the same medications as AOM with the addition of Zithromax to cover mycoplasma

A

bullous myringitis

71
Q

sudden decrease in otalgia and sudden development of otorrhea

A

TM rupture

72
Q

Tx for TM rupture

A

1st - Amoxicillin

augmentin
cefdinir

can also use olfoxacin or ciprodex as a topical

73
Q

what are low ototoxicity topical antibiotics

A

ofloxacin and ciprodex

74
Q

pseudomonas, proteus, s aureus

A

Chronic OM

75
Q

Topical tx: ofloxacin/cipro with dexamethasone for exacerbations

A

Chronic OM

can also be tx with oral cipro

76
Q

Definitive tx is surgical repair with temporalis muscle fascia

A

Chronic OM

77
Q

Abnormal growth of squamous epithelium in middle ear or mastoid

A

cholesteatoma

78
Q

concerns with this ear complication includes destruction of auditory ossicles

A

cholesteatoma

79
Q

deep retraction pockets with white mass behind TM

A

cholesteatoma

also see:
focal granulation at TM periphery
ear drainage >2 weeks despite tx
conductive hearing loss

80
Q

focal granulation at TM periphery
ear drainage >2 weeks despite tx
conductive hearing loss

A

cholesteatoma

also see:
deep retraction pockets and white mass behind TM

81
Q

treated with surgical debridement

A

cholesteatoma

also necrotizing COE if refractory to pharm tx

82
Q

Pus filling mastoid air cells, leading to bone erosion and cavity formation

A

mastoiditis

83
Q

proptosis of ear with fever

A

mastoiditis

84
Q

diagnosed via CT scan

A

mastoiditis

85
Q

Tx for mastoiditis

A
  • IV antibiotics for 7-10 days (use rocephin or cefazolin)
  • followed by oral ABX (augmentin or cefdinir)
  • followed by myringotomy
  • if this tx plan fails then consider mastoidectomy and debridement
86
Q

Systemic/IN decongestants

A

eustachian tube dysfunction
or
barotrauma

87
Q

intranasal steroids

A

eustachian tube dysfunction when due to allergies

88
Q

Hemotympanum

A

complication of barotrauma

89
Q

Perilymphatic fistula

A

complication of barotrauma

90
Q

Bony overgrowths of the ear canal

A

exostoses/osteomas

91
Q

repeated exposure to cold water is a risk factor for

A

multiple exostoses
must be treated w surgery

92
Q

What is the MCC of neoplasia of the ear canal?

A

squamous cell carcinoma

Clinical Med B (22 decks)

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